Question 1

A client is scheduled to have CABG surgery next week. To best meet the client's need for psychosocial support, which intervention by the nurse would be best?

Accepted Answer

All options are appropriate. However, since the psychological preparation of the client before surgery is so important, many hospitals have instituted preoperative educational classes. These classes greatly reduce client and family fear and apprehension.

Question 2

A client is scheduled to have a PTCA. The nurse brings the consent forms and the client questions why he/she has to sign a consent form for possible coronary artery bypass grafting too. The nurse's response should be based on understanding that (Select all that apply)

Accepted Answer

Complications of PTCA can include perforation of the artery or acute occlusion. In that case, CABG would be required. The client or family would need to sign a separate consent form for that procedure. In case of emergency, there might not be time to do so. The client who is sedated for the PTCA cannot sign another consent. It is standard procedure to have clients sign consents for both PTCA and CABG.

Question 3

A client had a PTCA with stent placement. Nursing care that can be delegated to the unlicensed assistive personnel (UAP) after the procedure includes (Select all that apply)

Accepted Answer

All options are appropriate care for the client after a PTCA and stent placement. However, the registered nurse must assess pulses. If the client complains of angina to the UAP, that person should let the nurse know. The nurse must assess the client before anyone calls for an ECG.

Question 4

A nurse is preparing to administer IV digoxin to an elderly client in heart failure. Which nursing action takes priority?

Accepted Answer

Digoxin's actions include slowing the heart rate to allow more effective filling. However, with its narrow therapeutic range, toxicity is common. One manifestation of toxicity is bradycardia. Nearly all health care institutions have policies that require nurses to check the client's pulse rate before administering digoxin and to hold the dose and notify the physician if the pulse rate is less than 60 beats/min. While all options are appropriate nursing interventions, option b takes priority.

Question 5

A nurse is conducting worksite health education classes. The nurse informs the participants that in order to prevent heart disease, the American Heart Association recommends which amount of exercise?

Accepted Answer

25% of Americans report no leisure time physical activity. The AHA recommends that to prevent heart and blood vessel diseases, individuals get 30-60 minutes of exercise on most days of the week.

Question 6

A client who is grossly overweight tells the nurse "I just can't lose a bunch of weight to prevent a disease I might not get." The best response by the nurse takes into consideration that

Accepted Answer

Coronary heart disease is the number one killer of both men and women. Obesity is a major risk factor not only because the heart has to work harder in an obese person but also because obesity is often associated with other risk factors. However, even losing 10-20 pounds significantly reduces one's risk.

Question 7

A nurse is caring for a client in the intensive care unit who underwent a CABG earlier this morning. Which nursing diagnosis takes priority?

Accepted Answer

Using the ABCs (airway, breathing, circulation), Impaired Gas Exchange would be the priority followed by Decreased Cardiac Output. Pain would be third because it is an actual, not a "risk for," diagnosis.

Question 8

A client is being discharge after successful CABG surgery. Despite the positive prognosis, the nurse cautions the client and family that

Accepted Answer

Postoperative depression, fatigue, incisional discomfort, dyspnea, and anorexia are common. By the fourth or fifth week, clients are feeling much better, and by 1 year after the operation, 93% report improved quality of life.

Quiz 56: Management of Clients with Functional Cardiac Disorders